Prehospital time and mortality in patients requiring a highest priority emergency medical response: a Danish registry-based cohort study

Elisabeth Helen Anna Mills, Kristian Aasbjerg MD, PhD, Steen Moeller Hansen, Kristian Bundgaard Ringgren MB, Michael Dahl MD, PhD, Bodil Steen Rasmussen, Christian Torp- Pedersen, Peter Søgaard, Kristian Kragholm

BMJ Open 2019 Nov 21;9(11):e023049

Objective: To examine the association between time from emergency medical service vehicle dispatch to hospital arrival and 1-day and 30-day mortality.

Design: Register-based cohort study.

Setting: North Denmark Region (≈8000 km2, catchment population ≈600 000).

Participants: We included all highest priority dispatched ambulance transports in North Denmark Region in 2006-2012.

Interventions: Using logistic regression and the g-formula approach, we examined the association between time from emergency dispatch to hospital arrival and mortality for presumed heart, respiratory, cerebrovascular and other presumed medical conditions, as well as traffic or other accidents, as classified by emergency dispatch personnel.

Main outcome measures: 1-day and 30-day mortality.

Results: Among 93 167 individuals with highest priority ambulances dispatched, 1948 (2.1%) were dead before the ambulance arrived and 19 968 (21.4%) were transported to the hospital under highest priority (median total prehospital time from dispatch to hospital arrival 47 min (25%-75%: 35-60 min); 95th percentile 84 min). Among 18 709 with population data, 1-day mortality was 10.9% (n=2038), and was highest for patients with dyspnoea (20.4%) and lowest for patients with traffic accidents (2.8%). Thirty-day mortality was 18.3% and varied between 36.6% (patients with dyspnoea) and 3.7% (traffic accidents). One-day mortality was not associated with total prehospital time, except for presumed heart conditions, where longer prehospital time was associated with decreased mortality: adjusted OR for >60 min vs 0-30 min was 0.61 (95% CI 0.40 to 0.91). For patients with dyspnoea, OR for >60 min vs 0-30 min was 0.90 (95% CI 0.56 to 1.45), for presumed cerebrovascular conditions OR 1.41 (95% CI 0.53 to 3.78), for other presumed medical conditions OR 0.84 (95% CI 0.70 to 1.02), for traffic accidents OR 0.65 (95% CI 0.29 to 1.48) and for other accidents OR 0.84 (95% CI 0.47 to 1.51). Similar findings were found for 30-day mortality.

Conclusions: In this study, where time from emergency dispatch to hospital arrival mainly was <80 min, there was no overall relation between this prehospital time measure and mortality.